Thursday, April 01, 2010

A short history of public health.

So, here in the US, the debate rages over the health care bill. Once you weed out politicians who were paid off by insurance companies, and the wealthy fearing new taxes, about the only argument left is "it isn't the government's job to offer health care". Well. Here is my reply to that.

For this, we're defining 'health care' as anything a government does to look after the health of its citizens. To do anything else would be picking and choosing and slanting things. Health is health. And it is in a government's best interest to keep its citizens healthy - otherwise, who else would they draft to fight wars? Governments started funding nutrition research after World War One, when a huge percentage of men drafted (45% in the UK, if I remember correctly, the book is in a box in SC) were rejected as too unhealthy or malnourished to fight. But it goes back a little further than that.

The first modern sewage system was built in one of the world's first planned cities, Mohenjo-Daro, of the Indus Valley Civilization, approximately five thousand years ago. The Romans built sewers as well as aqueducts for clean water, two thousand years ago. Then in the 1800s, Germ Theory was finally understood, and most of Europe and North America spent millions (in modern dollars) to build sewers. Eventually they were built in all major cities and most minor ones in the industrialized world. Tax dollars go every year to run waste water treatment, sewage treatment, and inspection organizations to keep our water clean.

The Pure Food and Drug Act founded the FDA here in the US in 1906, to safeguard the food we eat as well as everything we drink, and drug production and safety. It's still run by federal tax dollars. Germany is still running on a food purity law first put into effect in 1516 CE by the Duke of Bavaria. The Old Testament contains quite a lot of food laws, many involving safety and purity, going back, what, three thousand years? We think? Hammurabi's Code offers the death penalty for people watering beer. Chinese laws go back thousands of years, as well.

Vaccines. You know all those state programs pushing vaccines, advertising vaccines, keeping track of who has vaccines? The laws saying kids have to have them to get into school? You know who pays for the free ones offered in health clinics? The government. Here in the US they've been doing that for decades.

The Centers for Disease Control were founded as a branch of the Department of Health and Human Services in 1942. They look after all our sorry asses, developing new vaccines and monitoring the spread of diseases. They run on federal money. Always have. Without them there wouldn't be new influenza vaccines every year, among other things.

I could go on, but I think you're getting the idea. Technically, you could even say that traffic laws are a government-run system to preserve the health of the people. To claim that the health of the individuals in this country are not the problem of the government is ridiculous, unless we intend to shut down the Food and Drug Administration, the entire Department of Health and Human Services, cut all federal funding to hospitals, clinics, and doctors, shut down the water and waste treatment plants. That's not going to happen. So let's all pony up a few dollars to insure a couple million kids and keep them healthy, hmmm? Who do you think will pay your federally-funded social security when they grow up?


Catie said...

Interesting perspective - and I agree - though I'm Canadian (and Italian) so I've grown up thinking that health care and the health of citizens is a responsibility of government

MagicChupacabra said...

My big issue with it is the whole 'you must buy health insurance'. If I'm in a situation of food vs insurance I'm gonna go with food. Cause that can help me last long enough to get back on my feet.

Making people pay fines for not buying a private run service is kinda asinine.

If you're going to push a government mandated health system then make it a government run one, crank the taxes up a notch, and let me worry about other things.

The rest of the stuff can be fixed as time goes on.

Julie said...

Oh, there are a lot of specifics that are going to need fixed. I'm addressing the people who think it should never have been passed in the first place, in any form. You know, the ones who are probably on medicare or paid into or collect from social security. ;)

Nalamienea said...

Thank you for weighing in with an intelligent response. So much of this health care debate is so blown up that I don't blame the average American for not knowing what the hell they're talking about. I actively seek information about the health care bill and still am so turned around that I'm probably not fully informed.

I just think it comes down to this: we live in a society and everyone in the richest nation in the world should be able to have health insurance and every American should be embarrassed that isn't the case.

Nalamienea said...

I'm sorry... it's early that Health Care is one of my hot button issues I usually know better not to talk about. Please delete this message and the last part of the one above.

It's early and I'm not censoring myself properly yet. I apologize.

Melodye said...

The most concise, informed opinion I've read!!

Julie said...

Nalamienea, please don't apologize for any concisely, reasonably presented opinion. You're more than welcome to them. It's the irrational shrieking that drives me mad, and you certainly aren't doing that. :)

Emily said...

Unbelievably, I once knew a woman who didn't "believe in the Germ Theory".

However, when my kid came down with chicken pox (no vaccine back then) I called & asked if she wanted my kid to come over & infect her kid, which was the only way back then to make sure your kids didn't develop it as an adult. She sighed, and then said yes.

I had a friend who got it when she was about 20; she damn near died.

OK: my perspective tends to be that insurance is legalized extortion. But I recognize that one has to go with the common practice, so.... Definitely health care should be available for everyone; the limiting factor here is the profit motive, which in my humble opinion is obscene.

walterknitty said...

I also believe that making a profit off of other people's suffering is obscene. The US is the only industralized country in the world that does not offer health care to it's citizens. For all the overblown cries of "Death Panels" and "Health care is the same as the Nazi T4 program" what do some of these people think goes on in Canada, England, Switzerland, and France? No one should have to worry about going broke over medical care.

Louiz said...

I live in a country where healthcare is free at the point of treatment (one of the definitions of the UK health service) and watching the US talk shows getting whipped up into some kind of hysteria has me completely baffled. Why are they so against it? I saw one woman proclaiming that in the UK we're all being forced to do the healthy thing. Huh? Really? That would explain why we're all being force fed vitamins and cigarettes are banned. And of course food only comes in one portion packets... Not.

Anonymous said...

The thing that annoys me the most about Death Panels is what do they think the insurance companies are doing now when they deny coverage?

Sounds like they might be sending someone off to die to me.

Pam (who lives in the middle of republican land so I can't have a resonable discussion with anyone)

Nalamienea said...

I'm a Canadian living in the United States and my family back home is baffled too. They just don't understand the reason why people have to be FORCED to buy health insurance! but then again I think that making a profit as a Health Insurance company should be illegal. Profit is what is leading to all the problems in Health care... the reason why they drop people who get sick, the reason people lose their houses, the reason people with Cancer die when they can't afford service.

I think it really comes down to the right of the rich over the right of the poor in the US. They have a right to their HARD EARNED MONEY (in their minds) and the poor people who sit on their butts drinking beer instead of working (insert sarcastic inflections) will have to pry it out of their cold dead fingers.

Truly the whole debate makes me sick. We're more willing to pay to fight wars all over the world than we are willing to pay for the health and well being of our own citizens. They talk about astronomical Health Care costs, but it's the same people who argued to go on to an 8 year war in the same breath. What has that cost? Then that american citizen who's been permanently disabled fighting a VERY expensive war comes home to what kind of long-term care?

As an entire country I think the priorities are backwards. I get caught up with people who want to debate the finer points and I just don't care how it gets done. Everyone needs to be covered, period. I just get so emotional about the whole thing.

Mandy said...

Unfortunately, profit is also what drives new research into medicines and medical devices, so doing away with the profit motive entirely is not really a viable option either. I'll grant that there is a difference between the insurance companies and the drug and device companies, but an obscene profit is still obscene. It's all linked.

Yes everyone deserves access to health care, especially here in, as Nalamienea pointed out, the richest nation on earth (I've been uninsured at several times in my life, some of them with a small child, and it's a scary feeling to know that one illness or accident could financially destroy our family, evem if it didn't also literally destroy a member of the family in the process, 'cause I sure as heck couldn't afford to go to the doctor if I got sick during those periods.).

But I also know that we have a lot of advantages in this country in terms of quality and/or advanced technology of medications/devices available to us that aren't currently available in countries with more socialized health systems because there is no financial incentive for the companies to make them available in those countries.

It's a very tough line to draw.

Josee said...

Well said, and that goes to the previous comments as well.

Nalamienea said...

Mandy - I have to disagree with you on the idea that the profits here are what drive innovation. I think we could both agree that Japan has technological innovation that rivals that of the United States, yet their health insurance companies' profits are strictly limited by the federal government (to the point that the doctors have been known to walk off the job in protest). The difference is that the Japanese innovations have to be cheaper and more efficient to manufacture. In Japan an MRI costs $98 as opposed to the $1200 we pay here in the states because their health care laws force innovation that is cost effective.
(here's the link to the PBS article "Sick Around The World" where I got that stat.

Because of the limits on what health insurance can charge and what they can pay doctors, it also forces the administrative costs down - they have the lowest in the world at 2%, where ours in the united states is at something like 23%. It's a really interesting documentary.

Mandy said...

Nalamienea - I'll have to check out that article. Thanks for the link! But I don't know that MRI's are the best example of your point, considering that the commercial MRI scanner was developed in the US, and Toshiba only started manufacturing them 3 years after the US company. So the research and innovation that created the medical device was American - what the Japanese brought to the table was a more efficient manufacturing system.

Also, do we really want government controls on profits so tight that they cause doctors to walk off the job in protest? That, to me, seems like taking things too far in the other direction. Making a profit in and of itself is not a bad thing.

louise said...

Your post made me wonder: do you think people feel differently about government-funded healthcare because they have a concrete idea of how much it costs?

I mean, your average person would have no idea how much it costs to provide police, vaccines, sewerage, roads, or any other government-funded service. But thanks to the system of health insurance in the US, American healthcare consumers can see directly that their antibiotics cost $750, their son's collarbone X-ray cost $4000, and their mother's hip replacement cost $35,000. They then get the feeling that healthcare is EXPENSIVE.

... which of course, it is. And someone has to pay for it. But I think the whole debate is being coloured by an instinctive reaction which anyone would have to any major purchase: "that costs a lot of money. Do I really need it?"

Nalamienea said...

A good point Mandy, and Louise too. This is a fascinating debate and I wish we could have it over a glass of wine and face to face. :)

Mandy said...

That would be lovely, Nalamienea! I think I'll have a glass of wine tonight in honor of that suggestion!

I'm just glad that there are still people in this world who can discuss hot-button topics like this reasonably - it gives me hope for the world.

Julie said...

I'm glad to see everyone disagreeing like rational people, too! I've always thought it would be boring if everyone thought like I do, so it's nice to have differing opinions. It's also nice to see them expressed in rational manners.

Yay, blog readers! Y'all are great!

Tesha said...

There are some things that I think are needed with the health care bill, like the "pre-existing condition" bull. I've heard of cases where BABIES were denied because they were above the norm in weight, or people denied because of a genetic pre-disposition for certain diseases. It's ridiculous.

And I agree with Johnny, "crank the taxes up a notch, and let me worry about other things."

Amy Lane said...

ayup. 'nuff said.